Alyssa
Brzenski
Overview
 Basic statistics of Cleft Lips and Cleft Palate
 Basic embryology of Cleft Lips and Palates
 Common Associated Syndromes
 Anesthetic Implications
 Common complications
Cleft Lip/Palate Statistics
Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.
Risk Factors
Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.
Embryology
Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.
Facial Development
Cleft Lip Embryology
Cleft Palate
Non-syndromic Orofascial Clefts
Mossey et al. Cleft Lip and Palate. Lancet 2009; 374: 1773-85.
Pierre Robin
 Retrognathia
 Glossoptosis
Treacher Collins
 Mandibular hypoplasia
 Triangular facies
 Cleft palate
 Microtia
 Cardiac anomalies
 Renal anomalies
 Choanal atresia
Goldenhar Syndrome
 Orbital Distortion
 Mandibular Hypoplasia
 Ear Anomaly
 Nerve involvement
(auricular,
ophthalmologic, facial
nerve)
 Soft Tissue deficiency
Should I expect a difficult
intubation?
 7% of children for Cleft lip or Cleft palate
 Retrognathia
 Age less than 6 months
 Bilateral cleft
 Wide Cleft
 No difficulty ventilating
Anesthesia
 Mask Induction
 PIVx1
 Intubate and place an oral rae
 Balanced anesthetic
 Post-op Pain control with long-acting narcotic
 Infraorbital Nerve blocks for cle
 Awake on extubation to protect airway
 May have tounge stich
 Avoid oral airways
Infraorbital Nerve Block
Pediatric Peripheral Nerve Blocks. NYSORA.
Causes of Upper Airway
obstruction
 Edema of the tongue from the Dingman retractor
 Reduction in the size of the oropharynx
 Excessive sedation
Post-operative Palate Fistula
Causes
 Type of cleft
 Wound tension
 Type of repair
 Single layer repair
 Infection
 Age of patient at time of repair
Future Procedures
 Ear Tubes
 Palatoplasty- for velopharyngeal insufficiency
 Alveolar Bone Graft (8-10 years of age)
 Extensive orthodontic care
 Speech Therapy
Questions?
Sources
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Merrit L. Understanding the Embryology and Genetics of Cleft Lip and Palate. Advances in Neonatal Care 2005; 5: 64-71.
Arteau-Gauthier I, Leclerc JE, Godbout A. Can we predict a difficult intubation in cleft lip/palate patients? J Otolaryngol Head
Neck Surg. 2011; 40:413-9.
Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and Palate. The Lancet. 2009; 374: 1773-85.
Loose JE, et al. A Successful Algorithm for Limiting Postoperative Fistulae following Palatal Procedures in the Patient with
Orofacial Clefting. Plastic and Reconstructive Surgery. 2008; 122: 544-54.
Shan Phua Y, Chalain T.Incidence of Oronasal Fistulae and Velopharyngeal Insufficiency After Cleft Palate Repair: An Audit of 211
Children Born Between 1990 and 2004. Cleft Palate-Craniofacial Journal. 2008; 45: 172-8.
Cote, Lerman, Todres. A Practice of Anesthesia for Infants and Children. 2009. 4th Ed.
Tremlett M. Anaesthesia for Cleft Lip and Palate Surgery. Current Anaesthesia and Critical Care. 2004; 15: 309-16.